Individual provider Active NPI

Julia Corbo, CRNP

  • Gerontology Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1164739777
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP010726 Issued in PA
Practice address
111 S 11TH St
Gibbon BLDG, Suite 5480
Philadelphia, PA 19107-4824
Phone
(215) 503-7421
Fax
(215) 955-8966
NPI assigned
Sep 2, 2010
Last updated
Nov 10, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP010726 PA
Gerontology Nurse Practitioner 363LG0600X SP010726 PA Primary

Addresses

Primary practice location

111 S 11TH St
Gibbon BLDG, Suite 5480
Philadelphia, PA 19107-4824

Mailing address

111 S 11TH St
Gibbon BLDG, Suite 5480
Philadelphia, PA 19107-4824

Other identifiers 1

IdentifierTypeStateIssuer
102592880MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000612 PA Practitioner - Nurse Practitioner 6608058904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

925 Chestnut St
Mezzanine
Philadelphia, PA 19107-4290
Phone (215) 955-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP010726PAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince May 1, 2016 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

111 S 11th St
Ste 5480
Philadelphia, PA 19107
Phone (215) 503-7421

925 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-5050

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1164739777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "GIBBON BLDG, SUITE 5480",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "GIBBON BLDG, SUITE 5480",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-503-7421",
            "fax_number": "215-955-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORBO",
        "first_name": "JULIA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-02",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP010726",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP010726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102592880",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.